How did the field of transgender medicine move from general agreement that roughly one percent of trans people detransition, to more recently seeing the establishment of detransition-related care services in the USA and the UK?
Politics are a big part of this story, but the political angle neglects the underlying contested science—and the individual lives—that brought about clinical changes and cultural transformation beginning in the late 2010s.
This is what inspired us to write our forthcoming book, Understanding Detransition. It was just put into production and is expected to be published spring 2027. A huge milestone!
Starting to sketch out ideas for it was why we created this Substack account. When the newsletter first launched, its title brought up confusion among some of our initial readers: The One Percent.
Were we referring to rich elites?
Were we writing about trans people, long thought to be only one percent of the population (or even less)?
Or, were we reproducing a commonly quoted statistic, that only about one percent of people who transition regret it?
Trans-skeptical accounts regularly accused us of reifying the 1% regret rate, basically affirming it as a settled fact.
For some time, we deliberated over changing the title of the Substack to avoid misunderstandings. While our general ethos is of trans-affirmation, our research has also aimed at understanding detransition, identity fluidity, regret, and post-transition ambivalence. The book became about much more than individuals who experience detransition or regret. It is also about how knowledge is created, how science can be shaped by identity, beliefs, distress, and recurring political struggles over how its object is defined.
Ultimately, the book turned into a much bigger project than simply communicating our research results and it took a lot of careful editing to cap it at 90,000 words.
Below is an edited and condensed section that puts into clear view why we decided to keep our Substack’s original name, and why this particular statistic is so central to scientific and political struggles in transgender medicine.
The One Percent
The dominant story of gender transition in the West has long been one of triumphant self-discovery, authenticity, finding comfort in the body, and of lifesaving medical care. It has emphasised the expression of a true gender self after having been born in the wrong body. For years, a single statistic anchored gender transitions in the West: only one percent of those who medically transition ever detransition, regret treatment, or feel harmed by it.
The one percent became more than just a number. The figure did not simply describe outcomes; it organised the field of gender care itself. It guided transgender and nonbinary people contemplating hormonal and surgical interventions. In the case of gender diverse minors, it offered confidence to parents. It brought to life an affective framework, defining which post-transition emotions and medical experiences were legitimate to an emerging coalition of care providers, advocates, and institutions. It became a cornerstone of identity-affirming culture, clinical practice, and LGBTQ advocacy, and it created a script for which post-transition emotions could be spoken about. The one percent, as a rhetorical device, also implied that any stories of those who drifted away from the trans pathway were so statistically insignificant as to be anecdotal, or even deliberate “misinformation.”
Since the late 2010s, a set of surprising accounts began to gain visibility. Depending on who you ask, these experiences are met with hesitation, or they receive disproportionate—sometimes even glorified—focus. They come from individuals who speak of gender identities that are not fixed, of evolving gender journeys, of lives made more complicated by transitioning—not only by social conditions that can constrain gender diversity, but sometimes by the very medical interventions that were promised to alleviate distress.
These are the stories of detransition.
Understanding Detransition contemplates old and new clinical knowledge. It also blends it with contemporary informant interviews, and with our three contemporary research projects—Re/DeTrans Canada, the DARE study, and NORTASUN. Conducted between 2021 and 2024, these original studies collected data from 1,035 people living in the United States, Canada, and Spain. A large majority—nearly 70%—medically transitioned, meaning they initiated at least one hormonal or surgical intervention clinically indicated to treat gender dysphoria before they detransitioned. While robust methodology is crucial to research, as sociologist Arthur Frank notes, “after the methods, there has to be a story.” Our story is empirical and pragmatic: we contextualise our own research—revealing a wide range of detransition experiences and self-understandings—with trans studies, histories of LGBTQ healthcare politics, and philosophy, not necessarily to resolve tensions, but to make the connections impossible to ignore.
Within academic research, detransition has never had a widely agreed upon definition. In this sense, the struggle to define detransition is also part of the story we tell. Historically, gender clinicians applied the word “regret” indiscriminately to a range of unexpected outcomes, often disconnected from their patients’ emotional lives. Later, once detransition experiences became more culturally and clinically visible, a waterfall of euphemisms and new definitions started to flow into the academic literature. This is what sparked our curiosity most: not just that people reported different reasons for detransitioning, but that similar clinical outcomes were being described in radically different ways depending on who was listening. Detransition had become a canvas for competing ideas and values. Part of our work involved asking why. Answering that question required us to write about more than detransition itself, and we ultimately produced a sociology of knowledge and a history of science of the field of transgender medicine. This task laid bare that detransition is not at the margins, and that it’s not a rare anecdote, but central to unresolved uncertainties regarding gender dysphoria—trans medicine’s treatment object.
In conducting research for the book, something remarkable we noticed is that the one percent figure’s resilience has relied on changing clinical dynamics and the historical fluidity of the category today we call “detransition.” By controlling its definition, by redefining whose transness counts and who is considered a detransitioner, the magnitude and meaning of the phenomenon was contained for years before it eventually fractured.
As we argue, when detransitioning began to gain wider recognition, accounts of it were interpreted through competing lenses, organised by coalitions defined by their unique beliefs about transness, dysphoria, transgender medicine, and how detransition should be understood. Here, we draw from philosopher Dan Williams, who argues that many human communities function as belief-based coalitions: groups in which commitment to a specific set of ideas and values becomes a condition of belonging and to the group’s identity. He calls these identity-defining beliefs—convictions so bound up with community connections that questioning them risks social exclusion, while affirming them earns status and trust. Within these coalitions, members are incentivised to promote the interests of the broader collective, affirm shared beliefs, and suppress private doubts. Dissent is sometimes treated as betrayal.
Over the course of several decades, successive paradigms of transgender medicine have redefined transsexuality and dysphoria, which outcomes signal “regret,” and which experiences remain in clinical “zones of abandonment.” The result is a field where limited evidence has become a canvas for competing values, and detransition a site of scientific, clinical, and political struggle. We uncovered that the socio-political dimensions shaping knowledge about detransition can be broadly divided into two coalitions: the identity-affirming coalition and the transition-skeptical coalition. To make sense of how our research fits into the politics of gender care, we had to closely examine these groups as they vie to redefine care via fundamentally different values and beliefs.
To write this book, we took on the role of “double agents.” This is a concept coined by historian Joan Scott to describe actors who operate simultaneously within and against dominant discourses. Double agents make use of existing categories in order to render certain experiences intelligible, while also exposing those categories as historically contingent, politically charged, and dynamic. In this sense, some of our double agent work has involved using the terms “detransition,” “gender evolutions,” and “regret” to study and describe real, observable reality and to tether constructs to data-driven meaning. At the same time, we also interrogate how the meaning, boundaries, and legitimacy of these terms continue to be negotiated in real time by gender clinicians, activists, parents, institutions, trans people, and detransitioners themselves. The book we wrote is both a product of these negotiations and a map of it.
Confronting our own epistemic disruptions was what brought us to connect—in 2022—as scholars trying to make sense of our findings, engaging in self-reflection about our deeply held values, identities, and emotional lives within and outside the research. Our collective position—as a white Canadian transmasculine social scientist and a Spanish non-trans/cisgender psychologist and researcher—afforded us access to a broad range of perspectives, but it also carried the risk of reproducing the same commitments of our networks. Although we cannot control how our work will be taken up, we do take seriously the responsibility of presenting our data honestly, to avoid flattening complex lives in service of predetermined beliefs.
Some scientists distinguish between two attitudes toward academic literature: a “Book of Truths,” a definitive repository of settled facts and knowledge, and a “Book of Conversations,” an open and ongoing exchange of findings and questions.
After a year of writing it, Understanding Detransition became a book of conversations—with our research participants, with other scholars, with LGBTQ community advocates, and with our readers. By closely examining detransition, we wrote a story about science, society, and transgender medicine. It centres people who sought hormonal or surgical treatments for gender dysphoria and later experienced a change in their identity, desires for their bodies, or who expressed negative or ambivalent feelings after transitioning. This story asks how and why these accounts are now being called upon in the contemporary politics of gender care to guide what happens next. It also asks whether our systems of care can accompany people when their lives and identities—and the world around them—change.
But as we underline, the future of transgender medicine does not depend on how often detransition happens, but on which uncertainties are tolerable and whose suffering counts. Ultimately, detransition, in an entirely unique way, reveals the values, identities, emotions, and social relationships that can shape and reshape medical knowledge.
We are looking forward to offering our work in the spirit of these conversations.
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When can we read this book? I’m looking forward to it!
There is so much woolly, obfuscatory, noncommittal academic-speak in this Substack post that it's a labour to parse it. It's a "waterfall of euphemisms" to use the authors' own term. That it serves as an introduction to a forthcoming book does not bode well for the book.
As far as I can tell, if the introduction is any indication: it's a book about detransitioners that is going to spend a lot of time hand-wringing over the meaning of detransition, and apparently far less time pondering the obviously-more-paramount question of what transition itself means in the first place.
My sense is that the authors — whose stated "ethos is of trans-affirmation" — are trying to get out in front of the detrans narrative, to control it in such a way that the trans movement (their presumptive readership) doesn't have to completely reckon with the fatal flaws in trans ideology that the growing number of detransitioners otherwise exposes.
Framing such a book in terms of "conversations" rather than "truths" — i.e., skirting hard facts in favour of anecdotes — strikes me as an evasion tactic. Smells like cheap theology, like the stuff the nice minister lady at the local United Church might babble at you if you asked her why you should bother joining her dwindling congregation.
To use a stronger religion analogy: a trans identifier and a trans ideology supporter teaming up to write a book about detransitioners is rather like a pair of card-carrying Scientologists writing a book about all the ex-Scientologists who've flown the coop: you can't help but sense that all they're really doing is trying to stem the bleeding and salvage the cult they're foolishly too-far invested in. A couple of sunk cost fallacies, doubling down together.
And you can see it already in the strained academic jargon throughout the introduction: these are people whose stated goal may be to enlighten readers, but you can tell by their studious avoidance of framing anything in terms of objective material reality, they have their thumbs on the scale: what they really want is to palliate the fears of trans-identifying people and their allies.
(And by now we all know, trans-identifying people avoid objective facts like vampires avoid the sun.)
For example: they go on about the significance of the (long-debunked) "one percent" detransition statistic and how much it means within the trans movement. But they go to comically elaborate lengths to avoid directly dispelling it. FOR CHRISSAKES JUST SAY IT IN PLAIN ENGLISH: Clearly, vastly more than one percent of trans-identifying people are detransitioning. Say it just like that. Go on, I dare you! Instead, we get, "we're seeing the establishment of detransition-related care services" and talk of emerging alternative "narratives" and "paradigms". Oh, fuck off. People are leaving your cult in droves, and many of them were horrifically harmed by it. Just fucking say so.
(My sense of Kinnon MacKinnon's entire output of academic work over the last few years has been of someone whose personal life decisions — namely, transitioning — both cloud her ability to see the issue clearly, and drive her to frame the issue in extremely biased ways. This is someone channeling her own mental demons into academic work, which makes that work fatally biased and all but useless at contributing actual objective knowledge about the world.)
It's a sensibilty of "We concede that detransitioners are *interesting*... but trans is still fine! Pay no attention to the man behind the curtain! There's nothing to see here, ultimately!"
Some people might go for that sort of thing. Some might see it as a sort of olive branch between those "inside" and those on the outside the trans-ideology bubble. But I no longer hold such a conciliatory view to this kind of making-nice exercise. The time for that is long gone. By now these kinds of things just feel like people inside the bubble stalling for time as it begins to collapse around them.
Colour me EXTREMELY skeptical.
And I'll be specific about the fatal flaw as I see it:
The trans movement long ago ceased being about people making private personal decisions about their bodies and their personal senses of themselves: it involves coercing society at large to participate and play along with trans-identifying people's fictional "identities".
No one gets a double mastectomy in a vacuum: they do it because they think it'll put them in a category where *other people* are obligated to pretend not to see their sex. The "treatment" behind trans medicine — the part that actually does the work — is not in the patient's mind (and it's certainly not in their body), it's in the social environment that surrounds them. It's in the rest of us. WE'RE effectively YOUR treatment, and we haven't been given a say in the matter. Transition only "works" when trans-identifying people successfully bully everyone around them to *react* to their modified bodies the way the patients want them to.
"I got medical sex change treatments, so now you all HAVE to pretend I'm the opposite sex or you're bigots!"
When you can no longer use opposite-sex changing rooms or bathrooms without being rightly challenged, when your legal ID documents no longer coddle your feefees with a state-sanctioned lie about your sex, when people don't play along with your demands around pronouns, well, then, how exactly did all that surgery help you? I know that for a minuscule number of rational people who've transitioned, it still does. But I strongly believe that the vast majority of transitioners' motives lived all along in the eyes of their beholders: they wanted to take total control over how *everyone else* saw them and observed the facts about their bodies. And that's not how domocratic society — or shared reality — works. Nor is it a healthy foundation for mental health treatment. At all.
That's the fatal flaw behind the entire trans movement — it's the thing that locks people inside their bubble, certain that "transition" is the only thing that could have possibly alleviated their suffering (rather than, say, getting therapy to work through the toxic ideas they have about atypical gender expression), and condemns them to forever oppose everyone outside it — and it's why we're going to see more and more detransitioners come down the pipeline as the bubble's inevitable fate approaches. All bubbles eventually burst.
The introduction concludes with an implied but nevertheless blatant defence of trans medicine: it asks whether detransitioners are "tolerable uncertainties" and then solicits the preferred answer by asking "whose suffering counts". (In other words, detransitioners versus gender dysphoria sufferers: let's not get rid of trans medicine just because of a few pesky regretters!)
That whole framing is bullshit: firstly, and obviously, because framing detransitioners as collateral damage, even implicitly, even in a sly "just-asking-questions" way, is unethical. But even more broadly: no matter how much suffering gender dysphorics endure in their minds, they have no right to violate anyone else's boundaries in an effort to address their personal struggles.
Let's reframe the question, then: whose RIGHTS count? Because trans-identifying people's "gender" anguish doesn't override my rights. If you think "transitioning" will change my obligations in how I am supposed to pretend to see you, or how I'm obligated to address you, you're trampling on my rights and that's simply not acceptable. In that framing, the entire enticement to transition was a bogus and unrealistic idea right from the start — a covert cooking of the books to shift the burden of gender dysphorics' mental health problems over to everyone else's social obligations. The "medicine" part was just the rite of passage that sealed the transaction.
I highly doubt the authors are going to go anywhere near addressing these core issues. They're too busy distorting the issue behind carefully worded "waterfalls of euphemisms": it's all just "conversations" about everybody's varying and equally beautiful "beliefs". Heaven forfend actual, you know, objective reality stomps its nasty way into the picture...